Manic syndrome associated with multiple sclerosis: secondary mania?

Mania is generally assumed to be a "primary" affective disorder and is usually regarded as part of bipolar manic-depressive disease or as unipolar mania. Suggestions that manic states can be causally related to organic dysfunction--medical and pharmacological--are found in the most recent literature. These manic states are best considered "secondary" manias. We present a patient in whom mania occurred in association with multiple sclerosis. We assumed that, in this patient, the temporal coincidence of neurological and manic manifestations was not accidental, but that the manic state was caused by the demyelinating process. Multiple sclerosis is absent from the list of possible physical causes of secondary mania reported in literature, and we suggest that even multiple sclerosis merits consideration as a possible antecedent to secondary mania.